人中性粒细胞明胶酶相关脂质运载蛋白与2型肝肾综合征患者预后的关系

Effect of neutrophil gelatinase-associated lipocalin on prognosis of patients with type 2 hepatorenal syndrome

目的 探讨人中性粒细胞明胶酶相关脂质运载蛋白（NGAL）与2型肝肾综合征（HRS）患者预后的关系. 方法 以54例2型HRS患者为研究对象,并对其随访6个月,根据随访情况,分为生存组25例和死亡组29例,单因素分析比较血、尿NGAL,血肾素、醛固酮及肝功能生物化学指标的差异,采用Cox比例风险回归模型进行多因素分析寻找2型HRS患者预后的影响因素.计量资料组间比较用t检验,多组间比较用方差分析;计数资料以相对数表示,组间比较用x2检验;相关分析采用Pearson相关分析;生存分析采用Cox比例风险回归模型的前进法. 结果 HRS组血红蛋白、血小板、白蛋白水平显著低于肝硬化组和对照组,差异均有统计意义（P＜ 0.05）;HRS组INR、AST,ALT、总胆红素、直接胆红素、血肌酐、血NGAL、尿NGAL、血肾素和血醛固酮水平显著高于肝硬化组和对照组,差异均有统计意义（P＜ 0.05）;血、尿NGAL与血肾素、血醛固酮、血肌酐、MELD评分、Child-Pugh评分和腹水等级均呈显著正相关（P＜0.05）;生存组白蛋白、血钠、血肌酐、血NGAL、尿NGAL、血肾素、血醛固酮水平均显著低于死亡组,肾小球滤过率显著高于死亡组,差异均有统计学意义（P＜ 0.05）;Cox比例风险回归模型结果表明对2型HRS患者6个月生存情况有显著影响的预后因素为MELD评分、血NGAL、总胆红素和血肌酐,其相对危险度分别为1.214、1.157、1.098和1.016.结论 血NGAL在2型HRS患者中明显升高,是可预测其死亡风险的重要指标.

Objective To investigate the effect of neutrophil gelatinase-associated lipocalin （NGAL） on prognosis of patients with type 2 hepatorenal syndrome （HRS）.Methods A total of 54 patients with type 2 HRS were included in the study,and stratified for analysis according to survival status at 6-month followup：survival group,n =25; death group,n =29.Single factor analysis was used to compare the betweengroup differences for levels of plasma NGAL,urine NGAL,renin,aldosterone,and blood biochemical indicators.The Cox proportional hazard regression model was used to assess the prognosis of patients with type 2 HRS.The F-test,t-test,chi-square test,Pearson＆#39;s correlation analysis,and Cox regression model were used for the statistical analyses.Results The HRS patients with liver cirrhosis showed significantly lower levels of hemoglobin,platelets and albumin （all P 〈 0.05）,but significantly higher international normalized ratio and levels of aspartate aminotransferase,alanine arninotransferase,total bilirubin,direct bilirubin,serum creatinine,plasma NGAL,urine NGAL,renin and aldosterone （all P 〈 0.05）.Plasma NGAL and urine NGAL were positively correlated with renin,aldosterone,blood creatinine,MELD score,Child-Pugh score and ascites （P 〈 0.05）.The patients in the 6-month survival group showed significantly lower levels of albumin,serum sodium,serum creatinine,plasma NGAL,urine NGAL,renin,and aldosterone than those in the death group （P 〈 0.05）,but significantly higher glomerular filtration rate （vs.death group,P 〈 0.05）.The Cox proportional hazard regression model showed that MELD,plasma NGAL,total bilirubin and creatinine were influencing factors of 6-month prognosis for patients with type 2 HRS （relative risk：1.214,1.157,1.098 and 1.016 respectively）.Conclusion Plasma NGAL is high in patients with type 2 FHRS,and is associated with risk of death.